How Should We Treat Patients with Rotator Cuff Tears?
When a patient approaches us with a rotator cuff tear, our default response should no longer be shoulder surgery.
Over 5.7 million people in the United States over the age of 60 suffer from rotator cuff tears. Studies have shown that often the best option for these people is not surgery.
Physical Therapy as an Alternative to Surgery
Instead, nonoperative treatments such as shoulder pulley exercises can be recommended that result in significant improvement. Before opting for surgery, patients with rotator cuff tears should be encouraged to try a physical therapy program consisting of a variety of shoulder motion exercises.
Unfortunately, many people don’t realise what a help these exercises can be, and elect for shoulder replacement too soon. A small tear can be treated 83% of the time without an operation.
Most of the patients that decide to go in for surgery will do so within the first twelve weeks of a physical therapy program. After the first three months, it is very unlikely that a patient will choose to have surgery done.
Most patients with rotator cuff tears experience very few symptoms, but if it remains untreated a once asymptomatic tear may grow and begin causing serious pain. Patients may have trouble lifting their arm or sleeping. A physical therapy program can relieve them of these discomforts.
Physical Therapy Programs for Rotator Cuff Tears
Exercise promoting flexibility and strengthening has been proven to be a very effective pain reliever.
For many patients, it will be best to perform the physical therapy exercises in a supervised environment about once every week. The rest of the therapy can be done at home. The exercises should be simple enough to perform without a physical therapist present. Whether they are practiced at home or under supervision will not change their effectiveness.
This at-home nonoperative treatment includes range of motion exercises like those that can be performed using an over-the-door shoulder pulley. For patients, this a low-cost, convenient, and effective alternative to an operation. Typically, range of motion and flexibility exercises should be performed every day, with strengthening exercises every few days.
Once a patient has begun their range of motion exercises with postural exercises such as shrugs and pulling back their shoulders, they can move on to active assisted motion, performed using a cane or shoulder pulley.
The more patients we encourage to try a physical therapy program, the fewer will end up having to choose shoulder surgery. Our goal is to help people with shoulder injuries to recover the use of their shoulder without going through an operation.
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SOURCES: Kuhn, John E, et al. “Effectiveness of Physical Therapy in Treating Atraumatic Full-Thickness Rotator Cuff Tears: a Multicenter Prospective Cohort Study.” Journal of Shoulder and Elbow Surgery, U.S. National Library of Medicine, Oct. 2013, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3748251/.
Kuhn, John E. Exercise in the Treatment of Rotator Cuff Impingement: A Systematic Review and a Synthesized Evidence-Based Rehabilitation Protocol. 2008, http://kinesiologiarcb.com.ar/wp-content/uploads/2016/05/Exercise-in-the-treatment-of-rotator-cuff-impingement-A-systematic-review-and-a-synthesized-evidence-based-rehabilitation-protocol.pdf.
